Medicare Advantage plans are rethinking member experience

Kristin Rodriguez, Health Plan Alliance. August 18, 2017

One of my favorite moments during our Medicare Advantage Value Visit, July 19-21 was when Melissa Smith, Vice President, Stars & Quality Innovations with Gorman Health Group said the highest performing health plans are the ones “making old school new again.” The point she was making? That which sets high performing health plans apart is the ability to execute at the member level.  The flavor of how health plans are tackling that member-level execution differed with each case study we explored during our time together last month, and yet the same theme presented again and again, with every conversation.  Elevating and protecting the member experience is paramount to ensuring strong market position, better outcomes and higher star ratings.

The “member experience” is a relatively new, hot topic for MA plans, though really it’s just a consolidation of the efforts we’ve been making for a long time, reframed into a global strategy that is bringing leaders from across the enterprise together to tackle challenging issues like these: making member facing materials more palatable, leveraging digital channels to enhance engagement, evaluating our MA portfolio with an eye on social determinants of health and guarding against chronic loneliness, building dashboards our provider partners actually care about, so they can deliver the care to those members that need it most, and, finally, ensuring appropriate payment so that we can finance that care.


The challenge facing all Alliance member health plans and our provider partners as we seek to “execute at the member level” are the barriers we and our members face, which have traditionally been outside any health plan’s influence or control.  With the industry transformation to value based purchasing and the steady march of quality ratings programs’ focus to outcomes and experience, health plans must drive care from the clinic to the community, and forge partnerships that empower care for the “whole person.”  Our MA members face crippling chronic conditions like depression and diabetes, not to mention persistent loneliness.  And even for our healthy senior population, ensuring a benefit mix that supports long term health and happiness can be challenging when it comes time to submit a bid that both differentiates your plan and is sustainable.

Experts like John Gorman agree that Medicare Advantage is a sound investment for health plans, with strong market growth providing solid opportunity for health plans looking to diversify and perhaps stabilize their portfolio.  To become a high performing MA health plan, however, organizations must be willing to identify and remove barriers preventing them from executing at the member level.  No matter what’s potentially holding you back, you can bet another Alliance member health plan is facing a similar challenge, or perhaps has even found a way to solve it. Through ongoing networking in-person and virtually, and by sharing our tools and lessons learned, we can help one another make “old school new again.”


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:


Time Crunch Among Hurdles for Bipartisan Senate Push to Bolster ACA

The leaders of a key Senate committee say they are cautiously optimistic about reaching a deal to shore up the Affordable Care Act’s individual marketplaces, but even with a bipartisan effort, it is far from certain whether they can hash out an agreement in time.

Morning Consult

Friday, August 18, 2017

EpiPen maker to settle on claims it overcharged taxpayers, agrees to have pricing practices reviewed

Mylan will pay $465 million to settle claims that it overcharged states for its signature EpiPen, according to a Thursday Department of Justice press release. The company also signed an agreement with the federal government to enter into a review of its pricing practices.

Stat News

Thursday, August 17, 2017

Express Scripts to limit opioids, concerning doctors

The nation’s largest pharmacy benefit manager will soon limit the number and strength of opioid drugs prescribed to first-time users as part of a wide-ranging effort to curb an epidemic affecting millions of Americans.

Stat News

Wednesday, August 16, 2017

Federal deficit will soar to $194 billion, premiums spike 20% if Trump nixes cost-sharing subsidies, CBO report says

The federal deficit will soar by $194 billion over the next nine years and gross premiums for silver plans, the most popular, would spike 20 percent higher in 2018 and 25 percent higher by 2020 if President Trump follows through a proposal to eliminate the cost-sharing subsidies that allow low-income consumers to purchase and afford health plans on the individual ACA insurance exchanges, a report from the Congressional Budget Office said.

Healthcare Finance News

Tuesday, August 15, 2017

CMS cancels two mandatory pay models and scales back a third

The CMS on Tuesday said it will toss two bundled payment models and cut down the number of providers required to participate in a third, citing providers' requests to have more input in the models' designs.

Modern Healthcare

Tuesday, August 15, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Employer Surveys Project 2018 Cost Increases in the Five Percent Range

Employer Surveys Project 2018 Cost Increases in the Five Percent Range

by Clive Riddle, August 11, 2017


The National Business Group on Health has released results from their Large Employers’ 2018 Health Care Strategy and Plan Design Survey, which projects the total employer cost of providing medical and pharmacy benefits to rise 5% for the fifth consecutive year in 2018. The total cost of health care is estimated to be $13,482 per employee in 2017, and is projected to increase to $14,156 in 2018, with employers funding 70% of these costs. What is driving cost increases? The most often listed top driver was specialty pharmacy (26%) and 80% of employers ranked this among the top three cost drivers.


Similarly, last week Willis Towers Watson released preliminary findings from their 22nd annual Best Practices in Health Care Employer Survey, which found that "Employers expect health care costs to increase by 5.5%* in 2018, up from a 4.6% increase in 2017."


The NBGH 2018 survey also produced this grab-bag of interesting employer survey responses regarding health benefit strategies, regarding telehealth, onsite care, value based care, and CDHP:


·         96% will make telehealth services available in states where it is allowed next year

·         56% plan to offer telehealth for behavioral health services

·         20% of employers are experiencing employee telehealth utilization rates of 8% or higher

·         21%s plan to promote ACOs in 2018, and another 26% are considering offering them       

·         54% will offer onsite or near site health centers in 2018        

·         88% expect to use Centers of Excellence in 2018 for certain procedures        

·         40% of employers have incorporated some type of value-based benefit design

·         18% will use value-based benefit design to steer employees toward telehealth in 2018 (16% in 2017)

·         66% of companies will offer medical decision support and second opinion services in 2018

·         90% will offer at least one Consumer Directed Health Plan (CDHP) in 2018.

·         40% of employers will offer a CDHP as the only plan option in 2018, compared with 35% this year

·         28% pair a HDHP with a Health Reimbursement Arrangement


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:


Trump Plans to Declare Opioid Epidemic a National Emergency

President Trump said on Thursday that he was preparing to officially declare the United States’ worsening epidemic of opioid overdoses as a national emergency, accepting an urgent recommendation from a national commission that he appointed.

The New York Times

Thursday, August 10, 2017

Early 2018 marketplace rates vary widely across states

Health insurers selling individual plans next year on the federally operated marketplace,, have until Wednesday to finalize their rates. But early filings provide a good look at how the ACA marketplace is shaping up for 2018.

Modern Healthcare

Thursday, August 10, 2017

Bipartisan health policy coalition urges Congress to strengthen the ACA

An unlikely coalition of liberal and conservative health-policy leaders is calling on Congress to strengthen the existing health-care law in a variety of ways to help Americans get and keep insurance.

The Washington Post

Wednesday, August 9, 2017

Taking A U-Turn On Benefits, Big Employers Vow To Continue Offering Health Insurance

The shrinking unemployment rate has been a healthy turn for people with job-based benefits. Eager to attract help in a tight labor market and unsure of Obamacare’s future, large employers are newly committed to maintaining coverage for workers and often their families, according to new research and interviews with analysts.

Kaiser Health News

Tuesday, August 8, 2017

Large employers increasingly leaning on value-based contracts

Instead of looking to reduce demand by shifting costs to employees, large employers are increasingly hoping to constrain health insurance cost growth through value-based contracts with providers, according to a survey released Tuesday by the National Business Group on Health.

Modern Healthcare

Tuesday, August 8, 2017

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


More on Medicaid Satisfaction: J.D. Power finds Medicaid Members More Satisfied Than Commercial Plan Members

More on Medicaid Satisfaction: J.D. Power finds Medicaid Members More Satisfied Than Commercial Plan Members

by Clive Riddle, August 4, 2017

Recently, we  posted about The July 10 , 2017 Research Letter published in JAMA, A National Survey of Medicaid Beneficiaries’ Expenses and Satisfaction With Health Care, which found that “Medicaid enrollees gave their overall health care an average rating of 7.9 on a 0 to 10 scale. Forty-six percent gave their Medicaid coverage a score of 9 or 10, while only 7.6% gave scores under 5.” We noted these relatively high satisfaction levels occur despite a study published in the May 2017 Health Affairs: Outpatient Office Wait Times And Quality Of Care For Medicaid Patients which found Medicaid patients were 20 percent more likely than others to wait 20 minutes or longer. We also noted Medicaid managed care satisfaction rates were also measured last summer, under a survey commissioned by AHIP, which found 87 percent were satisfied with their Medicaid coverage and benefits.

This week J.D. Power published a 2017 Managed Medicaid Special Report, which concludes that “Medicaid recipients are more satisfied with their coverage than traditional, commercial health plan members.” Their study measured “overall satisfaction with managed Medicaid organizations based on six factors (in order of importance): provider choice; coverage and benefits; customer service; cost; information and communication; and claims processing. Satisfaction is calculated on a 1,000-point scale.”

The study found that:

·           Overall managed Medicaid satisfaction averaged a 784 score

·           The Medicaid average score was 78 points higher than the commercial health plan score for 2017

·           Medicaid enrollees indicate provider choice as the most important factor of overall member experience

·           In contrast, commercial members list coverage and benefits as the key driver of satisfaction

·           42% of Medicaid managed care members deferred medical treatments due to cost

·           40% of Medicaid managed care members avoided buying prescription medications due to cost

Given that Medicaid is administered and differs at the state level, the study addressed state differences, and reports that “Medicaid recipients in states where a dominant regional plan or a plan that owns a health system have the easiest access to doctors and hospitals, underscoring the importance of building robust networks and focusing on coordination of care between providers. Iowa, Tennessee, Arizona and Indiana have the easiest access to doctors and hospitals, compared with the other states included in the study.”

The report also share that “the states with the highest levels of satisfaction among Medicaid recipients are Utah (885), Iowa (859), Colorado (854), Arizona (840) and Virginia (840). The lowest-performing states in terms of overall recipient satisfaction are Kansas (683), Mississippi (686), Delaware (716), New Jersey (728) and California (731).”